Stress Fracture

What are they?
Symptoms
Possible Causes
Weight Issues
Treatment
Strengthen Your Calf Muscles


What are they?

They're small cracks in the outer lining of the bone. In runners stress fractures are generally found in the lower leg (tibia) and feet (metatarsals) but may also occur in the upper leg (femur), pelvis and spine.

Symptoms

• You may feel a dull ache to begin with in the general area.
• Or you may have sharp pain.
• Your bone may be tender to touch, even hot (sometimes called a
  hot spot).
• You may feel pain before you run which diminishes during your
  run. The pain then returns with greater intensity after you've
  stopped running.
• You may feel pain while you're sitting or lying in bed.
• In most cases you'll need a professional diagnosis which may require a bone scan. Stress fractures usually don't show up on x-rays.
• It's important for you to act quickly to prevent further cracking and fracturing of your bone.

• Sudden increase to your mileage, speed or hills.
• Overuse e.g. too much mileage, speed or hills.
• Running with very fatigued muscles.
• Excessive running on hard surfaces e.g. asphalt or concrete.
• Not enough recovery between your hard workouts.
• Running downhill on hard surfaces.
• Shoes that are worn out or don't provide enough support.
• Structural problems e.g. flat feet, knock knees, over pronation (rolling inwards), over supination (rolling outwards).
• Poor diet.
• Lack of calcium in your diet.
• Sudden weight loss e.g. too thin.
• Insufficient stretching of your shins.
• Muscle imbalance. You may have weak shins and strong calves.
• Tight Achilles tendon and calf muscles.

Women runners who train hard and have low-calorie diets or eating disorders may stop menstruating (known as amenorrhea). Research indicates that amenorrhea athletes have a two to four times higher risk of suffering a stress fracture than regular menstruating athletes (Nattiv 2000, ACSM 2007).

By eating a well balanced diet with sufficient calories you can help in the resumption of menses. Good nutrition builds strong muscles and bones, gives you energy to run and keeps you healthy.

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Treatment

• Complete rest from running for six weeks (maybe longer or shorter, everyone's injury is different so seek advice).
• Initially you may need to use crutches if you have stress fractures in your feet or lower leg.
• Seek professional advice on cross training options and a program to help you resume running. Non weight bearing exercise e.g. swimming or cycling are usually best but may not be suitable if you have foot fractures.
• Strengthen your calf muscles.
• Reduce your stride length by about 10%. It’s believed that by shortening your stride you’ll hit the ground with less force. It might seem strange at first as we all have our own style. But just bringing some attention to your stride will help.
• Include more calcium rich foods in your diet.
• Seek nutrition advice from a Registered Dietitian.
• Slowly build up your running when you start again.
• Increase your mileage by only 10% a week and not every week.
• Replace your old running shoes.
• Purchase shoes with more cushioning and support.
• Change your training from hard surfaces to softer terrain e.g. trails and grass.
• Stretch and strengthen your leg and feet muscles (e.g Achilles tendon, calf, etc).
• If you suspect foot problems see a podiatrist as you may need orthotics to correct pronation or supination.

Try simple calf raises to strengthen your calf muscles and reduce your risk of tibia stress fractures.

• Rise up on your toes and lower back down. Do 10-15 on each leg every day (or every few days) and build up to 30. Stretch your calf, both lower and upper, and Achilles tendon after wards.
• If you want more load, move your calf raises to a step. Place the ball of your foot on the step and let the heel hang over the edge. Rise up on your toe and then slowly lower the heel below the step.

  Again do 10-15 on each leg and build up to 30. Do these calf raises on your easy run days, not after a speed workout, hills or long run. Your calf muscles have already been taxed enough. Remember to follow with lots of stretching.

• You may want to take it even further by holding dumbbells while doing your calf raises.

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